The stories are made up, but the problems are real.

Hollywood broken leg theory

One of my friends has posted a bit under friendslock about dealing with a health-related thing that is also a work-related thing; you can see why this would be understandably private and not the sort of thing I would be poking this friend to unlock. So I wanted to pull what I was thinking out here where I can poke at it and not poke at my friend's private issues as well.

The thing is, I think we are, as a culture, sort of in love with the broken leg model of illness, injury, and disability.

Here's what makes the Hollywood broken leg model so shiny.

With a broken leg, you:*know what has happened.*know when it happened AND*know it right away.*know what to do to fix it.*know about how long it will take to heal.*know that it will not suddenly get less healed for awhile in the middle and then jump back to more healed again.*can easily predict which things will stress the injury.*know that it will be completely fixed when treatment is done.*have at least some theory of where the person experiencing it falls on the continuum of sinner ("What were you doing on top of that water tower at 3 a.m. anyway? You're lucky it wasn't your neck!") to saint ("Hit by a drunk driver while helping an elderly nun across the crosswalk? Let me fluff that pillow for you, you poor baby!").*do not have any doubt as a casual passerby whether there is something wrong, or what.

Of course, not all of this is actually true of broken legs, even! (I have edited in a few spots to add "Hollywood," because I want it to be absolutely clear that I know that my friends' leg injuries to not come with these magical advantages.) It's just the assumption from people who don't have the said broken legs. But it is a mighty convenient set of traits for an illness, injury, or disability to have. And the farther from this model your actual illness, injury, or disability goes, the more frustration you are likely to face from other people, because their questions are likely to be centered around the broken leg model.

Why didn't you go in sooner? they will snap. Sometimes they don't even notice that they are snapping, and if you point out that they're snapping, you need to stop being defensive. But see: if you break your leg, there are bits of broken leg sticking out, and you are an idiot for not going right in, right now! But what if you wake up just exhausted one morning? Should you go to the doctor that morning? "How long have you been exhausted?" the doctor will say. "Since this morning," you say. Wrong answer. Get more sleep, or less sleep. Get more exercise, or less exercise. Eat differently. Change something up. What if you feel a little dizzy? If you're female, does this correlate with your menstrual cycle? Well, if you've only had it for one day, you can't really say, can you? Why didn't you go in sooner? Because some things are not a broken leg. And if you get a history of going in and mentioning things that have not really been a problem very long, if you're not very lucky, you get a doctor who writes down "hypochondriac" or "drug-seeking," and then when it's still a problem later, you've got that to deal with. The cardiac surgeon's memoir I read recently acted as though women could go in with fatigue and find out whether they'd had a heart attack every time they had fatigue, since fatigue is the main symptom of heart disease in women, and I laughed and laughed. It is not some feminine perversity that makes that not happen. Really, really not.

Why don't you take meds for that? they will ask. Because naturally there are meds for that in existence. And they work for you. And they don't interact badly with anything else you have to take. It's just spite that makes you not take them, or spite that makes you take them wrong so that they don't work perfectly. This is the twenty-first century! They can fix things! Who can? You know--They! They can! Them! They would have already if you had only gone in sooner! What these people mostly want is for you to have a big plaster cast on your kidney, your endocrine system, your ears, or whatever else is not working--in some cases your actual broken leg that was not perfectly fixed by divine fiat somehow, because the world does not magically work like that--so it can fix the thing, they can sign it, and then in a few weeks somebody can come along and saw the thing off and everybody can go skipping merrily along. Most of us want this too. It just doesn't happen to work that way.

I'm pretty sure I do this to people, because one thing I've learned in the last few years is that we are all really terrible at spotting the ins and outs of illnesses, injuries, and disabilities not our own, so one of my new self-checks before I open my mouth is going to be, "Am I trying to treat this like a Hollywood movie of a broken leg again?" Too many of the formal things we have set up for employment and compensation are working on the broken leg assumption. The least we can do is not perpetuate them when we have the option.

On the flip side, when people say to me, "Oh, I'm so glad I don't have that problem" - which, by the way, is not a particularly nice thing to say - I want to tell them that they very well might and they ought to check. And I run the risk of being overly emphatic and seeing my own condition in other people when it isn't there. Because I said the exact same thing once, and I turned out to be wrong.

I particularly notice this with a type of cause-seeking (or, to put it less charitably, blaming) that sort of makes sense with a broken leg model but not so much with other things. For most people, leg bones don't just fracture on their own: even if someone has a predisposition to more-fragile bones, there's usually some physical trauma that casued a particular breakage. So it's reasonable (possibly overly-nosy, but reasonable) to ask how a break happened, because there's usually an answer like, "Skiing accident" or "car accident" or "tripped on the cat" or "slipped on the ice" or "attempted to create my own backyard high-wire act" or something.

(I won't say always, because there may very well be disorders that cause spontaneous bone breaks, but for most broken bones, there's a fairly clear proximate cause for the break.)

That isn't true, for the most part, of things like heart disease, or cancer, or depression, or autism, or whatever, but people insist on treating it that way. Did you eat the wrong foods, or did you not eat enough of the right foods? Were you too sedentary, or did you do the wrong kind of exercise? Were you stressed, or did you fail to have sufficient life goals to motivate you? And so on, and so on. That there must be a clear cause: you got X because you did Y, or you failed to do Z, or possibly because someone else did Q or failed to do R around you at the right, or wrong, time.

While I see this with other health issues I have, one of the simplest to explain is the fact that I have terrible teeth despite having great dental hygiene. I spent years brushing three times a day and flossing religiously and using all manner of fluoride supplement and avoiding soda and so on, and still having everyone from the dentist on down assume that there wasn't any possible way that I just had bad teeth: I must have done something bad to them, or failed to do something good to them. Until finally I found the dentist that I have clung to ever since, who noted quite reasonably that there's a genetic component to dental health, and some people just get unlucky. But the idea that All Mouths Start Off Perfect So You Must Have Done Something To Screw This One Up was so prevalent that it took years to get there.

That's an interesting comparison, the broken leg, because it's exactly the one my doctor made when I saw him yesterday. He deals with chronic pain himself, and we were discussing how people who have never had to do so don't understand how exhausting it is, and he said precisely that: "It's not like a broken leg," and for some of the same reasons you give.

(I do, however, have the "advantage" of my age--people expect those my age to be falling apart one way or another!)

In certain cases, it should be engraved on razor-edged steel sheets, folded to maximize the exposed edge, and, um, applied suitably to people who apparently are in need of a truly memorable experience on the topic.

I actually just had a broken foot, and it was pretty much Hollywood variety. Having had other ailments that weren't at all Hollywood, I really loved how clear and simple it was,even while hobbling around in a cast. The doctor didn't doubt that I really had it. The cure was not worse than the injury. The insurance didn't question the need for a cast or even X-rays. It didn't make me look weird (I happen to think a purple cast is glamorous). It meant that I got lots of attention and lots of support, because everybody can see a purple cast. And I didn't have to worry about the long-term side effects of the treatment, since they've been splinting broken bones for a while now.

I suffered much more debilitating pain with a nerve injury that went through three doctors before even being diagnosed, and then just when I thought it was well, came back double-strength.I took drugs that could have done some bad stuff to my liver, and I was irritable and cranky for months. And I couldn't go around announcing "I'm in hideous pain, feels like a giant bird has its claws in my neck," so I had to pretend I felt just like everyone else at parties and meetings. The only good aspect was that I did develop faith in the appropriate alternate medicine, and that's helped me with other things since.

When I think about problems like the one you suffer with, I can't begin to imagine the psychological and social problems it creates.

ETA: I know your real point was the blame-seeking that attaches to so much illness. Sorry to hijack with a slightly OT rant of my own, but I'd just been thinking about this.

Actually I did go to the doctor the first day I had fatigue, largely because Z made me, but also because it's so unusual for me. And I did get seen by a cardiologist and he said my heart was fine. The causes and identity of my mysterious illness of June-August last year remain utterly mysterious. (It appears to have been cured by pu erh tea.)

Belatedly this occurs to me: the broken leg model is very good for talking to people who are ashamed of their illness, usually emotional/mental stuff. A friend was once deeply depressed and on medication after, get this, her reunited-childhood-sweetheart-fiance left her six weeks before the wedding, then quickly married a much younger woman he'd just met. My friend was so ashamed that she couldn't just power on through!

Of course it is NOT the same thing as a broken leg, but the nice thing is that when your broken leg hurts, of course you get whatever treatment you need, no one says you should use willpower and fortitude instead of a cast and a doctor and painkillers and PT afterward.

Yeah, one of the first questions I get asked about the ankle is "how did you tear the ligament?" You'd think I would know, but I don't. Micro-tears over a period of years? Pressing deeper into neko-ashi dachi in karate, without realizing I fail at talar glide? That one time the nerve was twinging really badly in my ankle so I asked kniedzw to help me make the joint pop and maybe that was a really bad idea? All of the above?

And that is pretty close to a broken-leg injury, as such things go. But no, what happened was I had ankle pain for a little while, and then I had sensations that my foot was not as firmly attached as it should be, and then I went to a doctor -- some untold amount of time after the injury. So it goes.

[And I broke my back eight years ago in a suicide attempt; I don't go into the doctor for ANYTHING if I can help it because "attempted suicide" is on my medical notes several times and they act like I should be dead and stop wasting their resources] /wordvomitonastranger.

So much this. The broken leg has a clear trajectory, and the worst has already happened when you see the doctor, from there on - unlucky people aside - it gets better.

I've broken bones. Uncomfortable, but so far, touch wood, not a big deal. But take something like chronic bronchitis: some of the time it's so mild you can't diagnose it, sometimes it turns into an acute infection that doctors dismiss as 'you caught this one thing, everybody does', it has weird side effects, and if it doesn't inhibit your life too much, you'll get told that you're fine, dismissed. (Apparently spending five minutes in a hospital waiting room non-stop coughing and being unable to breathe is 'normal', I'm fine, I should eat less, that'll cure it. Bitter? Me?)

But at least I have a diagnosis and people-who-are-not-my-GP/the hospital specialist agree with me that not being able to breathe sucks.

People who suffer from weirder things (many of which include fatigue and/or intermittent pain) are having it harder still; so I'm sitting in the middle of the spectrum counting, as it were, my blessings.